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STRUCTIO, OR DISCHARGER CALIFORNIA STATE WATER RESOURCES CONTR. BOARD f. Remove COPY 4 (dark yellow) and use for your n forms. DISCHARGER SELF MONITORING REPORT � � 2. Use ballpoint pen or typewriter for data entry on forms. 3. Provide dates for beginning and ending in reporting period blocks. -U 'R ACY* CITY DIF - _I 4. Provide data as specified under column headings. �-ACIF')RN �A. f�E.is2`7 AL 7;Fd'iTER hDAf,,fTY I RACY STP' 5. Enter monthly summary data (MONTHLY AVERAGE, MONTHLY HIGH, etc.). CONTROL BOARD 6. Appropriate signature is required at the bottom of the form. CENTRAL VALLEY R.DCs�L1N "" s I. Remove COPY 3 and retain for your records '� ,r bOx L029 8. Send COPY 216 HA�Ke1jK $dLFdf'Cc7febb1dLCg7PWK4o{x ;;`x; 3201 S STREET zw -ACY CALIF SACRAMENTOI CA 95826 oa'53T6 YOUR REPORTING PERIOD IS P +T''L'� AND YOUR REPORTS MUST Ea BE SUBMITTED BY DAYS FOLLOWING THIS PERIOD. State NPDES Permit Year Mo. Day Year Mo Day Code Number Year Mo. Da � Transaction Facility c, Year/Month for r Reporting ❑ �� Date form was y ' 2 Code LD. --k - -=.L This report 7�,' Of Be ronin t `t computer printed 1y :;C} ,B j Period: 9 9 7` Ending Q6 ; ' G. STATION DESCRIPTION CONSTITUENT NAME 'S UNITS ... '� h n yz . $7 .,, �" <: w v, ✓� ; s ,5 r'� s"s +rCh �s a ar• �' row,],cah`$ SAMPLE TYPE , h FREQUENCY MONTH DAY 1 —_ _ _ -- ' '. C� z7 _ I _ __ice _ _ _ -- 1 - _ t _ - -- ems `' a.2 _ 5,- , ... 7_2..-1 7, L1` s+�w f _ _ i _ _IIN III _ -- - � _, 1 7 Z `I x, 73 /X _ " * -- -- _ — - -- �� P 7 22 _ —_ — _ � - -- _ — 7 -- — -- 15 J Ly — - - --- _ - - - - �V - - - -- U w= T -- y 1 — 11 ��iLV3'✓ 'J �J — / �' �1 J� — _ L — —1_L� --- dh u..— C 1 /1 G, --- r - _ 77 x/ i .0 —= i -- �; H ;- — ------------ _ i —..-� +,. — �': — <ws w .z. <n ..d -- --- — __-- siH'-4. .Evdr+{ — --- -- --- _ —_ — -- a --- t Z ��_Z— — T C2__ /c L �Z—s -- $ Z . .; ...�h + MONTHLY AVERAGE �` r,/ f 6, C 6� �. MONTHLY HIGH '] �. MONTHLY LOW TOTAL RECORDINGS/MO. REQUIREMENT #1 Times Exceeded REQUIREMENT#2 U Y Y, f, NN v' l j'4`ieSY'YC v_ i Times Exceeded r � a� � �„ t �. REQUIREMENT #3 r-Jinm—e, Exceeded r s *Enter number of samples Typad Name of Principal Executive Officer I declare under penalty of perjuryy that the foregoing is true and accurate, and that taken during The day. CO'tt Darrell D, the sampling procedure and analysis used for the column constituents was as spec- 1 L MI Pied in the Waste Discharge Order for this facility. - s.g noru re of Prmc Pol e.e��r vr. Mo Day COPY f0- Form 049 ]4 Last First V(4'cer or Author eed Agenr Date